Abstract
PURPOSE: Ankle fractures are increasingly common in the elderly and present unique challenges due to osteoporosis, comorbidities, and frailty. Management remains controversial, with surgical fixation generally favored, though the optimal approach is debated. This scoping review aimed to map current evidence on the management of ankle fractures in patients aged 65 and over, highlighting treatment strategies, outcomes, and gaps in knowledge. METHODS: A scoping review was conducted in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). We systematically searched PubMed, Embase, and Cochrane Library from 2010 to 2024. Eligible studies reporting treatment outcomes in elderly patients were included. Data were charted and summarized narratively; pooled descriptive analyses were presented to illustrate trends, consistent with PRISMA-ScR methodology. RESULTS: A total of 4783 articles were identified, of which 32 met the inclusion criteria. Of the 32 studies analyzed, 24 were conducted in Europe, 5 in the United States, and 1 each in China, Korea, and New Zealand. Study designs comprised 27 retrospective observational studies, 3 randomized controlled trials, one prospective case series and one ambispective cohort study. Open reduction and internal fixation remain the standard surgical method, while alternatives such as tibiotalocalcaneal nailing and fibular intramedullary nailing are increasingly reported. Overall functional recovery was satisfactory, but outcomes varied by comorbidity burden, fracture pattern, and rehabilitation strategy. Complication rates were substantial, with wound problems, fixation failure, and infections most frequent. Mortality ranged from 10 to 27%, with higher rates in nonoperative and frail populations. Evidence on weight-bearing protocols and long-term outcomes remains inconsistent. CONCLUSIONS: Current evidence supports surgery as the preferred option for most elderly ankle fractures, though individualized, multidisciplinary care is essential. Research gaps include standardized fixation protocols, comorbidity-adjusted pathways, and long-term functional outcomes. High-quality prospective studies are needed to refine clinical recommendations.